Provider Demographics
NPI:1881005460
Name:RIVERVIEW PSYCHIATRIC MEDICINE, PC
Entity Type:Organization
Organization Name:RIVERVIEW PSYCHIATRIC MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:I
Authorized Official - Last Name:PARDELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DFAPA
Authorized Official - Phone:845-471-1807
Mailing Address - Street 1:370 VIOLET AVE
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601
Mailing Address - Country:US
Mailing Address - Phone:845-471-1807
Mailing Address - Fax:845-471-1815
Practice Address - Street 1:370 VIOLET AVE
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1034
Practice Address - Country:US
Practice Address - Phone:845-471-1807
Practice Address - Fax:845-471-1815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-16
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166228-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty